Millions of us rely on them regularly to alleviate pain and discomfort, but may take some over-the-counter medications possibly cause us to suffer more?
This is the unsettling finding of recent research by Canadian experts who examined what occurs in back-pain patients who use anti-inflammatory medications such as ibuprofen or aspirin.
This latest study, published in the journal Science Translational Medicine, reflects several prior studies suggesting that, contrary to common sense, opioids taken for merely a few days may produce chronic symptoms by interfering with the body’s critical natural healing mechanisms.
The private healthcare organization Nuffield Health estimates that over 24 million Britons suffer from chronic pain. We spend more than £90 million annually on over-the-counter anti-inflammatory medications such as ibuprofen and aspirin in an attempt to solve such issues.
However, are we wasting money? The new report from McGill University in Montreal, Canada, reveals that inflammation that occurs in aching backs and joints, although being swollen, red, and painful, really aids in the relief of acute pain (the short-term discomfort we get from an injury).
Additionally, it prevents the discomfort from becoming chronic (defined as lasting longer than 12 weeks). And inhibiting that first inflammation, while it may provide short-term pain relief, may interfere with this normal process and lead to pain that is more difficult to treat later on, warn the experts.
The study examined the health records of approximately 500 individuals with lower back pain from the UK Biobank database including the health records of half a million Britons.
I wish I hadn’t taken the initial dose.
46-year-old Angela Putney Hillsley is a native of Clacton-on-Sea, Essex.
Four years ago, my life was ordinary. I was a busy mother who worked as a home-based child support worker. My weekends were spent socializing with my 48-year-old spouse, Steve. Life was lovely.
One day in 2018, I was kneeling with my daughters Jade, 23, and Kayla, 21, sorting clothes on the floor of my bedroom. When I got up, I heard a popping sound, and my left leg immediately began to hurt.
I limped towards the kitchen. I took some paracetamol and hoped that the pain would subside. However, the discomfort only intensified. A month later, I was unable to ascend the stairs without crying. Steve brought me to A&E, where I was given an X-ray and an MRI.
They provided me with crutches, and two weeks later, when I returned to see the consultant, he informed me that there was a tumor in my knee. I was awestruck.
A few days later, I underwent a full-body bone scan, which, happily, revealed that the tumor was benign and not malignant. I was instructed to return to my primary care physician for pain management, who, one month after my diagnosis, prescribed me Oramorph — liquid morphine — and gave me six months off work.
Six months after the accident, though, I was falling asleep continuously due to the morphine, and the pain appeared to be worsening. My physician prescribed stronger drugs, including morphine patches. Regardless, I continued to decline.
The agony was relentless and severe, but the drug-induced fatigue was nearly as bad. I was unable to leave the sofa. I canceled social events and stopped leaving my residence. My family was stunned. I was nothing like my previous self.
My leave of absence had expired, and I was forced to quit. I was heartbroken because I liked my job.
My primary care physician referred me for counseling, group therapy, and even mirror therapy with a physiotherapist to determine whether my movements were causing discomfort. Nothing has succeeded.
No one ever indicated that the medicines could be exacerbating the situation, even though they made me nauseous and disoriented and failed to ease the pain. I desired to taper off the medicines but lacked the courage to do so on my own. I told my doctor that I wanted to amputate my leg since the pain is so unbearable.
Now I am unable to work, rarely leave the house outside of medical appointments, and am no longer the mother, wife, or friend I once was. I take 33 painkillers and other medications every day to control the pain and deal with the adverse effects of certain medications.
I wish I had never taken that first dose of morphine because I am still in pain.
Those who took anti-inflammatory medications such as ibuprofen to treat it were more likely to experience pain up to 10 years later than those who did not take anti-inflammatory medications. This effect was not observed in individuals who took paracetamol, which dulls pain but does not reduce inflammation.
Why must this be the case? Neutrophils, a type of white blood cell, appear to play a crucial part in the pain processes of both humans and mice, according to the findings of the researchers.
Neutrophils are the most common type of white blood cell in humans and serve many functions inside our immune systems.
In addition to capturing and destroying invading bacteria, they can also be important for regulating inflammation levels in response to an infection or injury, such that the inflammation aids in healing but does not become excessive and cause more damage.
Typically, they arrive at the scene of the injury early in the inflammatory phase, when the damage begins to hurt, around the same time as many of us begin to take analgesics. When the McGill team inhibited the action of neutrophils in mice with an injury, the animals’ agony lasted up to ten times longer than usual.
They discovered that anti-inflammatory medications, despite offering temporary pain relief, had the same impact of prolonging discomfort. According to Jeffrey Mogil, a professor of pain studies at McGill University and one of the study’s co-authors, it may be preferable not to prevent inflammation but rather to allow neutrophils to perform their anti-inflammatory duties.
It appears to be dangerous to interfere with inflammation, as it occurs for a purpose.
What we have been doing for decades appears to be not only incorrect but 180 degrees incorrect. You should not inhibit the inflammatory response. You should allow the inflammation to occur. This is what relieves chronic pain. Therefore, it may be preferable to take medicines that do not inhibit inflammation, such as paracetamol, or, if possible, to endure discomfort with the awareness that it is part of our natural healing process.
It is not the first recent indication that we may be better off without painkillers while experiencing an unpleasant twinge. A large new study published this week in the Journal of the American Medical Association concluded that the key to managing persistent back pain is mental retraining, not medication.
Australia’s University of New South Wales offered 138 back-pain sufferers a 12-week brain-retraining program, in which participants did specialized brain exercises designed to alter their perception of their disease such that it was no longer viewed as a flaw or a barrier to movement.
This enabled them to do an increasing number of physical movements, including lunges, which boosted their strength and decreased their pain. By the end of the course, the pain scores had decreased by nearly half.
Not only over-the-counter pain relievers can make matters worse. Opioid-induced hyperalgesia is a condition in which patients experience chronic pain as a result of the considerably more potent painkiller morphine, which is available only on prescription.
The unknown is the prevalence, although a 2014 study published in the British Journal of Anaesthesia cautioned that individuals given high doses of opioid medicines after surgery are likely to experience more post-operative pain, which can develop into long-term chronic pain.
In 2018, researchers from the University of Colorado at Boulder, U.S., found that lab rats administered opioids to alleviate pain after stomach surgery suffered agony for at least three weeks longer than rats not administered opioids.
The study, published in the journal Anesthesia & Analgesia, also discovered that repeated opioid dosages can prime glial cells in the spinal cord to be more sensitive to pain.
Worst of all, devastating data indicates that using morphine to alleviate the excruciating pain of a heart attack may reduce a person’s likelihood of survival. This is because the medication appears to inhibit the body’s normal stem-cell healing mechanism.
In reaction to the physical anguish of a heart attack, the body normally sends stem cells to the damaged heart to repair and regenerate tissue. When morphine blocks this pain, however, the stem-cell repair response is also stopped.
Paolo Madeddu, a professor of experimental cardiovascular medicine at Bristol University, made this discovery in 2012. His study, which was published in the journal Circulation, determined that after a heart attack, pain signals from cardiac nerves serve to attract stem cells from bone marrow to repair damage to the heart muscle and restore blood flow after a clot has deprived the heart of oxygen-rich blood. The studies were conducted first on mice, then on human patients.
‘The real sense of pain may be very significant in this case,’ he argues, ‘since it appears to initiate physiological processes involved in the repair mechanism’
Professor Madeddu told Good Health that the latest McGill University study on anti-inflammatory medicines and back pain “is different from our study on pain after a heart attack — but it has something in common in terms of the inhibition of the healing response.”
Regardless of whether the medicine is ibuprofen, aspirin, or morphine, the lack of healing inflammation appears to be the issue, according to him.
He says that any injury can cause the production of inflammatory-like cells. These cells possess curative properties. In the event of a heart attack, blood cells assist recovery by quickly encouraging the production of new blood arteries, as shown in our Circulation publication. If the response is hindered, however, the initial acute injury and tissue damage might become chronic.’
Dr. Rajesh Munglani, a consultant in pain medicine at Cambridge’s Royal Papworth Hospital, concurs that inflammation, as unpleasant it may seem, is necessary.
“Inflammation is part of the healing process,” he continues. “This explains why long-term use of anti-inflammatory medicines can cause severe damage to the gut lining, as they limit the inflammatory response in the gut, which is part of the gut’s self-repair mechanism.”
Because anti-inflammatories are a blunderbuss that suppresses both pain and healing, they should be used in the smallest amount for the shortest duration possible.
Dr. Munglani suggests that those who take anti-inflammatories on a long-term basis — for weeks and months as opposed to days — try taking them every other day. “Take every other day off and try something new,” he advises. ‘If you have chronic joint pain, for instance, you can apply ice packs to the troublesome areas and use natural medicines like ginger and curcumin.
“Chronic pain might have numerous biological and psychological reasons,” he adds. Rather than relying on a single medication, I advise patients to try a variety of treatments to determine what may be effective for them.
However, Dr. Franziska Denk, who investigates the neurological system’s role in chronic pain problems at King’s College London, is more skeptical of the latest McGill University findings.
She says, “It’s a very fascinating study, but it has to be duplicated in greater detail to corroborate its findings.” I would not recommend anti-inflammatory medicines such as Smarties. However, if I had recently injured my back, I would continue to take ibuprofen for around three days.
She adds, “I wouldn’t use it for more than a few days.” If you take more than 15 ibuprofen pills each month, you increase your risk of migraine headaches, according to scientific evidence.
However, according to Professor Madeddu, it is recommended to avoid anti-inflammatory medications for back pain because they are ineffective. Several meta-analyses (where data from multiple previous trials is integrated to produce statistically sound conclusions) indicate that the medications provide only a very minor’ reduction in acute pain symptoms, according to the author.
In 2020, the renowned Cochrane Library will conduct a comprehensive review of 32 prior research projects.
Instead, extensive large-scale studies, such as one published in 2015 in the journal Annals of the Rheumatic Diseases by the University of Sydney, have recommended that chronic back-pain sufferers engage in regular gentle exercise to build muscles that support and protect the back and help to heal injuries, which for some patients could include Pilates and yoga.
Professor Madeddu states that there is little evidence that anti-inflammatory medications should be used to treat chronic pain.
Instead, it may be more beneficial to investigate the causes of people’s chronic pain. It may be because these individuals continue to disregard simple recommendations such as losing weight, exercising, and maintaining perfect posture at work and when resting.
